Chad Cook’s research while affiliated with Duke University and other places

Background Degenerative cervical myelopathy (DCM) is a clinical syndrome characterized by a progressive compression of the spinal cord. DCM often looks like common symptoms of aging or bilateral carpal tunnel syndrome in its early stages, requiring careful differential diagnosis. Identifying DCM is a real challenge as no validated screening tools are available for making the DCM diagnosis. Potentially, individuals with DCM may experience misdiagnosis or substantial diagnostic delays, with an enhanced risk of irreversible neurological consequences if not promptly addressed. Despite the increasing prevalence, there is a lack of awareness about DCM among both the public and healthcare professionals. However, patients may seek physiotherapy to obtain a diagnosis or access treatment. Methods A comprehensive (non-systematic) review of the literature about DCM epidemiology, pathophysiology, clinical presentation, diagnostic methods, and management was conducted. Results A guide and essential knowledge to facilitate clinicians to understand DCM and to enhance clinical reasoning skills, performance and interpretation of the examination are provided. Interdisciplinary collaboration and optimal referral methods are also handled. Conclusion The aim of this article is to summarize and enhance physiotherapists’ essential knowledge of the differential diagnosis and management of patients with DCM.

Introduction There is a high incidence of shoulder injuries among overhead athletes. Identifying and understanding risk factors for these injuries, particularly those that can be modified, is a necessary step towards being able to effectively develop and implement shoulder specific injury prevention programs. Therefore, the purpose of this systematic review was to identify risk factors associated with a new onset of shoulder pain and injury among the athletic population. Design Systematic Review. Methods A systematic review of the literature was performed within PubMed, Embase, AMED, CINAHL, and EmCare databases. Studies were screened utilizing the following inclusion criteria; (a) athletes currently pain free or no history of pain at baseline, (b) athletes with shoulder and or arm pain originating from a musculoskeletal shoulder problem (c) risk factors captured prospectively (d) pathoanatomy and biomechanics in isolation or in addition to personal characteristics, etc. (e) reporting relative risk, odds ratios, and/or hazard ratios and (f) follow up ≥ 6 months. Due to data heterogeneity, only a descriptive data synthesis was performed. Data were extracted and underwent risk of bias assessment utilizing the Quality in Prognosis Studies (QUIPS) tool. PRISMA guidelines were utilized throughout. Results Nineteen papers were included. A total of four studies investigated baseball, five handball, three swimming, two tennis, two military, one cricket, one American football, and one with multiple sports, totaling 7,802 athletes. The risk of bias among the included studies was rated from moderate to low overall with no single study being identified as high risk of bias. All studies designs were a level of evidence of II except for two studies that were level III. The most significant risk factors included range of motion, reduced strength, history of local/regional musculoskeletal pain, previous injury, and training load. There are inconsistencies in how injury and pain are defined within studies. Conclusion Many risk factors are easily objectifiable and modifiable which may help in developing shoulder injury mitigation strategies. Three of the five significant risk factors for injury can be identified by objective pre-screening measures. While previous pain and injury cannot be mitigated, training loads should be closely monitored and adapted according to other risk factors and the athlete’s response. Level of Evidence 2

Myofascial pain syndromes (MPS) affect a significant portion of the population. However, they remain controversial because their etiology, diagnostics, and effect mechanisms rely on theoretical frameworks with limited scientific rigor. This viewpoint highlights three main challenges and proposes solutions: First, diagnosis lacks consistent criteria and they are at risk of verification and incorporation biases. Tightened diagnostic criteria and differentiating myofascial pain syndrome from competing conditions will improve accuracy in research and clinical practice. Second, the etiology/pain mechanisms are poorly understood, with symptoms overlapping other conditions. We recommend recording of standardized assessments in national registries including psychological stress and systemic factors to identify distinct phenotypes. Third, the mechanisms behind treatments such as myofascial release and acupuncture are unclear. We advocate for mechanistic clinical trials to uncover how these treatments exert effects. Addressing these challenges will enhance understanding, diagnosis, and treatment of MPS and guide policymakers to fund appropriate research.

Rationale Neck pain is a major cause of disability worldwide, and current rehabilitation strategies show limited effectiveness. Subgrouping patients by their primary pain and disability drivers can help tailor treatments. At this end, the Pain and Disability Drivers Management (PDDM) was developed and has demonstrated preliminary effectiveness in the management of low back pain. Nevertheless, the PDDM model was only validated for this population. Adapting this framework to patients with neck pain would provide a more global view of the patient's experience of pain and support a genuine biopsychosocial intervention. Aims and Objectives The aim of this study was to develop and validate the content of the PDDM model for patients living with neck pain. Methods Through a modified DELPHI study design, participants with clinical and research expertize in rehabilitation of neck pain were invited to participate. A questionnaire was developed using literature reviews and endorsed by a steering committee. The relevance of each element of the newly adapted model was evaluated on a 4‐point Likert scale. An item reached consensus if it obtained the predefined threshold of > 78% “relevant” and “very relevant.” Participants left comments on terminology and recommended items to add in early rounds. Quantitative and qualitative analyses were performed. Results An invitation was sent to 1650 potential participants, from which 155 accessed the survey, 64 completed the first round and 55 the second round. A total of 70 elements met consensus and were distributed across six domains: “Nociceptive pain drivers”, “nociplastic pain drivers,” “drivers associated with neuropathic pain”, “comorbidity drivers”, “cognitive‐emotional drivers” and “environmental or lifestyle drivers, and social determinants of health.” Conclusion Through a modified DELPHI study, the PDDM model was updated and adapted to people with neck pain. Subsequent steps include clinical integration and measures of efficacy when used for assessment/treatment.

Mechanistic studies on manual therapy (MT) have potential to allow better understanding of ‘why’ and ‘how’ MT interventions provide an effect. Contextual factors (CF) include the multitude of intrinsic and extrinsic inputs outside of the specific intervention which influence response. CFs must be accounted for within both clinical and mechanistic trials. The influence of CFs provides several challenges and opportunities which are outlined within this commentary. Researchers should consider the specific purpose of their research when developing mechanistic trials to establish if controlling versus recording CF is warranted based on their aim(s).

Background: Scapular dyskinesis is a known risk factor for shoulder pain, making it important to screen for prevention. Physical therapists screen scapular dyskinesis by visually comparing asymmetries in scapular movement during overhead reach using the Scapular Dyskinesis Test Yes/No classification (Y/N). Although scapular kinematics has been used to quantify scapular dyskinesis, current measurement techniques are inaccurate. Optimal scapular muscle activity is crucial for normal shoulder function and is measured using surface electromyography (sEMG). Research suggests that impaired scapular muscles can lead to scapular dyskinesis. Despite kinematics being a poor reference standard, there is currently no validated method to identify movement asymmetries using muscle activity as an alternative. We utilized sEMG to establish Y/N's validity. We hypothesized that Y/N is a valid tool using sEMG as a viable surrogate measure for identifying scapular dyskinesis. Methods: We employed a known-groups (symmetrical vs. asymmetrical shoulders) validity design following the Standards for Reporting Diagnostic Accuracy Studies. Seventy-two asymptomatic subjects were evaluated using Y/N as the index test and sEMG as the reference standard. We created a criterion to assign the sEMG as the reference standard to establish the known groups. We calculated the sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV, NPV), likelihood ratios (LR+, LR-), and diagnostic odds ratio (DOR) using a 2 × 2 table analysis. Results: The diagnostic accuracy values were Sn = 0.56 (0.37-0.74), Sp = 0.36 (0.08-0.65), PPV = 0.68 (0.49-0.88), NPV = 0.25 (0.04-0.46), LR+ = 0.87 (0.50-1.53), and LR- = 1.22 (0.50-2.97). Conclusion: The Y/N's diagnostic accuracy was poor against the sEMG, suggesting clinicians should rely less on Y/N to screen scapular dyskinesis in the asymptomatic population. Our study demonstrated that sEMG might be a suitable alternative as a reference standard in validating methods designed to screen movement asymmetries.

Objective The aim of this study was to identify prognostic factors pertaining to neck pain from systematic reviews. Data sources A search on PubMed, Scopus, and CINAHL was performed on June 27, 2024. Additional grey literature searches were performed. Review methods We conducted an umbrella review and included systematic reviews reporting the prognostic factors associated with non-specific or trauma-related neck pain and cervical radiculopathy. Prognostic factors were sorted according to the outcome predicted, the direction of the predicted outcome (worse, better, inconsistent), and the grade of evidence (Oxford Center of Evidence). The predicted outcomes were regrouped into five categories: pain, disability, work-related outcomes, quality of life, and poor outcomes (as “recovery”). Risk of bias analysis was performed with the ROBIS tool. Results We retrieved 884 citations from three databases, read 39 full texts, and included 16 studies that met all selection criteria. From these studies, we extracted 44 prognostic factors restricted to non-specific neck pain, 47 for trauma-related neck pain, and one for cervical radiculopathy. We observed that among the prognostic factors, most were associated with characteristics of the condition, cognitive-emotional factors, or socio-environmental and lifestyle factors. Conclusion This study identified over 40 prognostic factors associated mainly with non-specific neck pain or trauma-related neck pain. We found that a majority were associated with worse outcomes and pertained to domains mainly involving cognitive-emotional factors, socio-environmental and lifestyle factors, and the characteristics of the condition to predict outcomes and potentially guide clinicians to tailor their interventions for people living with neck pain.